<?php
/* @var $this NdkHealthController */
/* @var $model NdkHealth */


$this->breadcrumbs=array(
	'Ndk Healths'=>array('index'),
	'Cetak',
);
?>


<h1>Cetak Manage Nota Debet/Kredit Medical</h1>


<div class="form">

    <?php $form=$this->beginWidget('bootstrap.widgets.TbActiveForm', array(
	'id'=>'ndk-health-form',
	// Please note: When you enable ajax validation, make sure the corresponding
	// controller action is handling ajax validation correctly.
	// There is a call to performAjaxValidation() commented in generated controller code.
	// See class documentation of CActiveForm for details on this.
	'enableAjaxValidation'=>false,
)); ?>

<div class="row">
		<div class="col-md-4">
			<div class="widget box">
				<div class="widget-header">
					<h4><i class="icon-reorder"></i> Form Cetak </h4>
				</div>
				<div class="widget-content">


<div class="control-group">
<label class="control-label required" for="NdkHealth_endorsement_no">
Policy No
<span class="required">*</span>
</label>
<div class="controls">
<input id="policy_no" class="form-control" type="text" name="NdkHealth[policy_no]" size="20" maxlength="50">
</div>
</div>


			</div>
			</div>
			</div>
			</div>

<div class="row">
		
		<div class="col-md-12">
		  <div class="form-actions">
        <?php echo TbHtml::submitButton('Cetak',array(
		    'color'=>TbHtml::BUTTON_COLOR_PRIMARY,
		    'size'=>TbHtml::BUTTON_SIZE_LARGE,
		)); ?>
		</div>
		</div>
	</div>

    <?php $this->endWidget(); ?>

</div><!-- form -->